Ask the hospital’s lawyer: 3 medical dilemmas

Also: CDC survey raises mental health alarm for teen girls; how to reduce your exposure to PFAS [View in browser](    [❤️]( February 14, 2023 Hi CommonHealth reader, [Last week]( I introduced you to Emma Melton, the lawyer who’s on call to deal with emergencies at Mass General Brigham. As senior legal counsel, part of her job is working the legal hotline. Social workers, nurses, doctors and others can call — any time of day or night — to ask about legal dilemmas that arise during their work. The clinician lays out the situation, and Melton tells them what the law says. Sometimes she has a few hours to think it over, but often the clinician needs an answer immediately. To give readers a window into what kinds of questions Melton's job involves, I presented three hypothetical situations in last week's newsletter. Thank you to everyone who shared their thoughts. We heard the full range of responses. At least one person (a non-lawyer, I might add!) got the answers spot on. And the [Hippocratic]( [Oath]( came up, although that’s more of an ethical doctrine than a legal one. Here is how Melton would respond in each of the scenarios: Scenario #1: No place to go An elderly man no longer needs to be in an acute-care hospital, but he does need the support of a rehabilitation facility. However, because of a history of violence, his medical team cannot find any facility that’s willing to take him, and his family is unable to provide the care he needs at home. What should the medical team do? Should they discharge this patient? Should they keep him in the hospital indefinitely? Something else? Answer: The patients stays put Melton said the man would stay in the acute-care hospital — sometimes for months or longer — even though it’s not medically needed. That's because the hospital has an obligation to provide a safe and appropriate discharge for all patients. Rehab facilities and long-term care facilities get to decide who they accept. Should they all decline, the hospital keeps the patient "if they can't go home," Melton said. She acknowledged this isn’t ideal for the patient, who needs rehab services and would likely prefer a quieter setting than a hospital. “Setting aside that tragic reality, it's also kind of ridiculous that they're just taking up this acute-care bed. That's a poor use of financial resources, a poor use of medical resources,” Melton said, noting that there’s a bed shortage at many hospitals. Scenario #2: Who decides for the fetus? A woman with substance use disorder is using drugs that are dangerous to the fetus throughout the pregnancy. She indicates to her medical team that she intends to continue using. Can her providers stop her from using drugs or do something else to protect the fetus? Answer: It's up to the pregnant person Under Massachusetts law, a fetus only becomes a person once born. Thus, the mother has full bodily autonomy until delivery is complete. “The legal premise that the fetus does not have independent rights supports our abortion rights in Massachusetts,” said Melton. “[The Department of Children and Families] cannot take custody of a fetus prematurely because, legally, there’s no child until it is born.” Once the child is born, the clinicians can contact DCF. And under state law they are required to do so if they believe a child is in danger of abuse or neglect. But that call has to wait until after delivery and is dependent upon the clinicians having indications that the infant is at future risk. It's also worth noting that only DCF can take custody of the child, which the hospital isn't allowed to do. (The hospital can offer services to help address substance use disorder, but those are entirely voluntary.) Scenario #3: Estranged family A woman loses consciousness in a car accident. Her health care proxy form is decades old. It says her husband should make medical decisions for her, but they’ve been estranged — although not divorced — for a long time. Who gets to make decisions about this woman’s medical care? Answer: Sometimes the court does In Massachusetts, a health care proxy is automatically revoked due to divorce — but not separation or estrangement. Usually, Melton says the estranged partner will turn over responsibility to someone more appropriate. But sometimes, Melton said, hospital staff get into a difficult situation where the unconscious patient doesn't have a new partner and doesn't have family who can step into the role. “We're stuck with the quandary of: Do we turn to that [estranged] person anyway? Or do we just get the court to appoint a total stranger because we're not sure we trust the husband’s goodwill towards this estranged partner?” said Melton. If the care team is questioning the person's intentions (like if they seem to be eyeing money in the patient's will), then the hospital may ask the court to appoint what’s referred to as a “corporate guardian” — a volunteer appointed to make medical decisions for the patient. A court would also weigh in if there were an estranged partner and a current partner battling over health care decisions. “Some circumstances can get quite oppositional, which is an awful component to add on top of the already stressful situation of being in the hospital,” said Melton. That’s one reason she urges everyone to double check that they have an updated [health care proxy form]( and share a copy with their physician. Gabrielle Emanuel Health reporter [Follow]( Support the news  This Week's Must Reads [PFAS expert tips: How to reduce your exposure to harmful ‘forever chemicals’]( PFAS chemicals are in our water, our food, our air and on our skin. And they are linked to a long and growing list of medical concerns. WBUR spoke with scientists about what changes they’ve made in their own lives and what they recommend to avoid PFAS. [Read more.]( [PFAS expert tips: How to reduce your exposure to harmful ‘forever chemicals’]( PFAS chemicals are in our water, our food, our air and on our skin. And they are linked to a long and growing list of medical concerns. WBUR spoke with scientists about what changes they’ve made in their own lives and what they recommend to avoid PFAS. 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These challenges are taking a toll on more than just patients: In the past 13 years, the number of doctors deciding to retire early has tripled, they report. The largest state-run medical system in the world — and much cheaper than the U.S. system — the NHS has long been a point of pride for Brits. It gives everyone access to good quality care regardless of ability to pay. So, even as politicians look for reforms, they are not considering making people pay directly for health care, Luhnow and Colchester report. At least that core tenet seems to be holding strong. "The distance traveled for people coming from out of state has now tripled." — Nancy Stanwood, chief medical officer of Planned Parenthood of Southern New England, on the [uptick in patients]( traveling to the region after the Supreme Court's Dobbs decision. ICYMI [Black women are more likely to get sick and die from pregnancy. 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NPR's Michaeleen Doucleff [reports]( that as global temperatures rise, fungi could evolve to like hotter temperatures — something closer to our body temperature. (Fortunately, there's still no evidence fungi can turn us into zombies, like in "The Last Of Us.") 😎 Forward to a friend. They can sign up [here](. 📣 Give us your feedback: newsletters@wbur.org 📧 Get more WBUR stories sent to your inbox. [Check out all of our newsletter offerings.]( Support the news     Want to change how you receive these emails? Stop getting this newsletter by [updating your preferences.](  I don't want to hear from WBUR anymore. Unsubscribe from all WBUR editorial newsletters [here.](  Interested in learning more about corporate sponsorship? [Click here.]( Copyright © 2022 WBUR-FM, All rights reserved.